Medical Larceny

I don't usually share the family mail, but this letter from my son Ben to the CEO of the curiously named "Daughters of Charity Health System" illustrates two important issues: (1) how inadequately covered many insured people are, and (2) how the medical system shamelessly gouges us. Yes, we need universal health insurance, and United Professionals, the new organization I helped create, energetically advocates for it. But universal health insurance won't work, at least not for long, if the medical system treats it as an open vein gushing with profits.

The odd thing is that many politicians and pundits believe that the only way to control health costs is to get consumers to limit their consumption of health care - as if an appendectomy, for example, was a kind of self-indulgence. In my son's case, we have someone who is vividly aware of his health care costs, if only because he bears so much of them. His letter is not only an individual complaint but an act of good citizenship. We all need to be prepared to blow the whistle on medical larceny.

But where are the regulatory agencies that should or could be watching for this kind of thing? How can we build price controls into universal health insurance in a way that does not limit necessary health care, or fall unfairly on the poor? Obama, Hillary, John and the rest of you: Do you have some answers for us?

As of today my son has received no response from Mr. Issai.

Robert Issai

President and CEO

Daughters of Charity Health System

26000 Altamont Rd.

Los Altos Hills, CA 94022-4317

Dear Mr. Issai:

I recently suffered from appendicitis, and was admitted to the emergency room at Saint Vincent Medical Center in Los Angeles on November 10 of last year. I underwent an appendectomy and was released from the hospital on the morning of November 12. I have no complaints about the quality of my care. My surgeon, Dr. Charles Hunter, was excellent, and with very few exceptions all of my encounters with hospital staff were as pleasant as they could be under the circumstances. But I received a profound and unpleasant shock shortly after returning home. The bill arrive, account number XXXX, if you're curious.

I was charged -- am being charged, I should say, as I have not yet paid -- $15,833 for the care I received during the 40-odd hours I spent at Saint Vincent. I then received additional bills from the surgeon, the anesthesiologist, and the emergency room physician for their respective services. (The latter is asking for more than $800 for the approximately three minutes he spent at my side.) I am a freelance journalist, and I am fortunate enough to have health insurance at the moment. Blue Cross covered $12463 of your bill. But $3370 is still a considerable sum of money, so I telephoned the billing office and asked for an itemized account of the charges.

I hardly know where to begin. Perhaps with the $21 I was charged for each of ten 10 ml saline IV flushes. I do not know the going rate for a 500 ml bottle of saline solution at CVS, but considerably less than $105, I am sure. I was charged $80 for each of three 50 cc doses of .9% sodium chloride, a few spoonfuls of table salt, and $154 for each of twelve one-liter bags of sugar water. For my pajama pants -- of such flimsiness that I would be hard-pressed to find their equivalent at a 99-cent store -- I was charged $35. Given such absurdities, it seems hardly worth mentioning that I was charged $982 for an hour and three quarters spent unconscious on a gurney in the Recovery Room and $1768 for each night of room and board. Rents are high in Los Angeles I know, but that is nothing less than an outrage.

A few weeks later, I was doing a little research to find out where to send a friend who had broken her ankle in New Mexico and needed surgery in Los Angeles. One of your own orthopedic surgeons advised me to use another hospital. "Saint Vincent is notorious for overcharging its patients," he said. This was not news to me. Another example: my friend was charged $1.05 for a 2 ml dosage of fentanyl at the ER in Albuquerque. At Saint Vincent I was charged $71 for a 250 mcg injection of the same. Assuming a standard 50 mcg/ml concentration, you overcharged me by a factor of approximately 28. I can only congratulate you for your chutzpah.

Mr. Issei, if you were in any other line of work, no one would hesitate to call you a thief. I understand the complexities of our healthcare system better than most do, but this is inexcusable, and all the more so in an institution that masks itself with the gospel of charity. Medicine is a noble profession. You render it shameful. I am sure you have better insurance than I do. I wish you good health, and poor sleep.